Volume 68, Issue 11 p. 2542-2550
Clinical Investigation

Potentially Inappropriate Medications Are Associated with Increased Healthcare Utilization and Costs

Collin M. Clark PharmD

Collin M. Clark PharmD

Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA

Primary Care Research Institute, Department of Family Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA

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Amy L. Shaver PharmD, MPH

Amy L. Shaver PharmD, MPH

Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA

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Leslie A. Aurelio BS

Leslie A. Aurelio BS

Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA

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Steven Feuerstein MS

Steven Feuerstein MS

Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA

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Robert G. Wahler Jr. PharmD

Robert G. Wahler Jr. PharmD

Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA

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Christopher J. Daly PharmD, MBA

Christopher J. Daly PharmD, MBA

Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA

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David M. Jacobs PharmD, PhD

Corresponding Author

David M. Jacobs PharmD, PhD

Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA

Address correspondence to David M. Jacobs, PharmD, PhD, 316 Pharmacy Building, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY. E-mail: [email protected]Search for more papers by this author
First published: 05 August 2020
Citations: 46

Previous presentation: These results were previously presented at the American College of Clinical Pharmacy Annual Meeting, October 26, 2019, New York, NY.

Abstract

BACKGROUND/OBJECTIVES

To examine the prevalence of potentially inappropriate medication (PIM) prescribing and its association with healthcare utilization and related expenditures utilizing nationally representative data from the United States.

DESIGN

Retrospective cohort study.

SETTING

The 2011–2015 Medical Expenditure Panel Survey (MEPS).

PARTICIPANTS

Community-dwelling sample of U.S. adults aged 65 and older during the first round of each MEPS cycle.

MEASUREMENTS

A qualified definition operationalized from the 2019 American Geriatrics Society Beers Criteria® was used to estimate the prevalence of PIM prescribing over the study period. Negative binomial models were assembled to examine associations between PIM exposure and healthcare utilization including hospitalizations, emergency department (ED) visits, and outpatient provider visits. Generalized linear models with the log link function and gamma distribution were used to analyze associations between PIM exposure and healthcare expenditures. Sensitivity analyses were conducted utilizing inverse probability treatment weighting using propensity scores for being prescribed a PIM.

RESULTS

The period prevalence of PIM prescribing over the 5-year sample was 34.4%. PIM prescribing was positively associated with hospitalizations (adjusted incidence rate ratio [aIRR] = 1.17; 95 confidence interval [CI] = 1.08–1.26; P < .001), ED visits (aIRR = 1.26; 95% CI = 1.17–1.35; P < .001), and outpatient provider visits (aIRR = 1.18; 95% CI = 1.14–1.21; P < .001). PIM exposure was associated with higher marginal costs within outpatient visits ($116; 95% CI = $105–$243; P < .001), prescription medications ($128; 95% CI = $72–$199; P < .001), and total healthcare expenditures ($458; 95% CI = $295–$664; P < .001). Similar results were found in our propensity score analyses.

CONCLUSION

PIMs continue to be prescribed at a high rate among older adults in the United States. Our results suggest that receipt of PIMs is associated with higher rates of healthcare utilization and increased costs across the healthcare continuum. Further work is needed to implement evidence-based deprescribing interventions that may in turn reduce unnecessary healthcare utilization.